AB0960 EFFECT OF BODY MASS INDEX ON TREATMENT RESPONSE OF BIOLOGIC-/TARGETED SYNTHETIC DMARDS IN PATIENTS WITH RHEUMATOID ARTHRITIS, PSORIATIC ARTHRITIS AND AXIAL SPONDYLOARTHRITIS
Authors: C. G. Gialouri, M. Pappa, G. Evangelatos, E. Nikiphorou, G. E. Fragoulis
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Overweight and/or obese patients with inflammatory arthritis (IA) have higher disease activity and lower chances of achieving as well as maintaining the treatment targets. Obesity also appears to negatively affect the response to tumor necrosis factor (TNF) inhibitors in patients with IA. The efficacy of other biologic (b) and of targeted-synthetic (ts) DMARDs in overweight/obese patients with IA, including rheumatoid arthritis –RA, psoriatic arthritis –PsA, axial spondyloarthritis –AxSpA, is unclear. <h3>Objectives</h3> To conduct a systematic literature review (SLR) to explore the effect of weight/body-mass-index (BMI) on the efficacy of all b-/ts-DMARDs approved for the treatment of RA, PsA and AxSpA. <h3>Methods</h3> For this PROSPERO-registered SLR, we searched PubMed, Scopus and Cohrane-Library up to June 21<sup>st</sup> 2022. PICO-format was as follows: Population: adults with RA, PsA or AxSpA and low/normal weight/BMI; Intervention: treatment with approved b-/ts-DMARDs; Comparator: adults with RA, PsA or AxSpA and high/abnormal weight/BMI; Outcome: any outcome used for the assessment of treatment response (e.g DAS28, ACR20, drug-survival). The search query included the following keywords in the article's title and/or abstract: ("psoriatic arthritis" OR "rheumatoid arthritis" OR "inflammatory arthritis" OR "ankylosing spondylitis" OR "axial spondyloarthritis" OR "non-radiographic axial spondyloarthritis") AND (DMARDs OR bDMARDs OR tsDMARDs OR tofacitinib OR upadacitinib OR baricitinib OR filgotinib OR apremilast OR anti-TNF OR etanercept OR infliximab OR adalimumab OR golimumab OR certolizumab OR abatacept OR rituximab OR tocilizumab OR anti-IL-6 OR anti-IL-17 OR anti-IL-23 OR anti-IL-12/23 OR ustekinumab OR guselkumab OR risankizumab OR secukinumab OR ixekizumab OR "janus kinase inhibitors" OR "JAK inhibitor") AND ("body mass index" OR BMI OR obes* OR weight). Clinical-trials and observational studies were included. The screening and selection process was conducted independently by two reviewers. Risk of bias (ROB) was assessed using the RoB2-Cochrane tool and Newcastle-Ottawa scale for randomized and non-randomized studies, respectively. <h3>Results</h3> Out of 996 references, 192 full-text articles were reviewed and 75 eventually fulfilled the inclusion criteria (of which 10 studies were retrieved through manual-search). Number of studies, most of which were of medium RoB, was: 34 for TNF-inhibitors, 4 for IL-12/23 inhibitors, 1 for IL-23 inhibitor, 7 for IL-17 inhibitors, 18 for tocilizumab, 8 for abatacept, 3 for rituximab and 5 for JAK-inhibitors. The efficacy of TNF-inhibitors was found to be affected by the BMI in all forms of IA with the effect being similar across various TNF-inhibitors. In contrast, the favorable results of IL-23 and IL-17 inhibitors do not appear to be influenced by increased BMI in patients with PsA or AxSpA. Similar evidence exists for tocilizumab and abatacept, while no conclusion can be drawn for rituximab. More data are needed for JAK-inhibitors, although the effect of weight/BMI does not seem to be significant so far (<b>Figure-1</b>). <h3>Conclusion</h3> Weight/BMI should be considered in the treatment-plan of patients with IA, with its effect being more pronounced for TNF-inhibitors compared to other b-/ts-DMARDs. <h3>Acknowledgements</h3> None. <h3>Disclosure of Interests</h3> Chrysoula G. Gialouri: None declared, Maria Pappa: None declared, Gerasimos Evangelatos: None declared, Elena Nikiphorou Speakers bureau: honoraria/speaker fees from Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly, Fresenius, Grant/research support from: research grants from Pfizer and Lilly, George E. Fragoulis Speakers bureau: has received honoraria/speaker fees from AbbVie, Genesis, Pfizer, Novartis, Lilly, UCB, Janssen, Amgen and Aenorasis.